Photos: Effects of smoking, sun and stress on the skin of twins

Brenda and Barb

Age: 52

A trifecta of smoking, sunning, and lower weight means that Brenda (left) looks significantly older than Barb (right), who lives near her in Ontario, Canada. (“I love being called the younger one,” Barb says, laughing.) Brenda has smoked half a pack a day for 14 years, while Barb has never smoked. Brenda also reported seven times more sun exposure (primarily over eight to ten weeks of the year for 30 years, at an estimated 14 hours a week, versus two hours a week for Barb). “The festoons of loose skin” under Brenda’s eyes are attributable to her cigarette habit, says Dr. Bahman Guyuron, a plastic surgeon at Cleveland's Case Western Reserve University “When I see that [on patients], I don’t have to ask if they smoke. I know they do.”
(Department of Plastic Surgery, University Hospitals Case Medical Center)
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Janet and Jean

Age: 54

Jean (right) looks older than Janet (left), Guyuron says, noting her darker undereye area, deeper smile lines, and “more numerous and deeper vertical frown lines.” The probable reason, his study suggests, is that Jean is divorced (after 27 years of marriage), whereas Janet has been married for more than three decades; nothing else measured in the history of these Chicago-area sisters was different. In general, marital trouble, separation, and worries about money and finding a new partner can result in stress levels that affect appearance, Guyuron says.
(Department of Plastic Surgery, University Hospitals Case Medical Center)
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Laurie and Lisa

Age: 46

Laurie (left), who lives in Pennsylvania, weighs 38 pounds less than Lisa (right), in North Carolina — which explains the eye wrinkles and deeper smile lines that reach almost to the corners of Laurie’s lips, Guyuron says. Lisa’s extra weight provides some filling for her smile lines and makes her face look smoother overall. This is one of several examples from the study showing that “in twins over 40, more weight gives a younger appearance,” says Guyuron.
(Department of Plastic Surgery, University Hospitals Case Medical Center)
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Charlotte and Rebecca

Age: 48

These San Antonio twins underwent two different types of gastric weight-loss surgery. Rebecca (right) lost 80 pounds, while Charlotte (left) dropped a great deal more — 220 pounds — to wind up 4 pounds lighter than her sister at the time of this photograph. Guyuron says that Charlotte’s dramatic loss of fat caused skin looseness and rippling (similar to what happens to the surface of a balloon when the air is let out). As a result, her face is thinner and her forehead wrinkles and smile lines are deeper than her sister’s.
(Department of Plastic Surgery, University Hospitals Case Medical Center)
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Jeanne and Susan

Age: 61

Jeanne (left) is the twin who commented that her sister looks “ten years older” — in fact, the researchers upped that to an 11-and-a-quarter-year edge. The reasons for Susan’s condition are that she smoked for 16 years of her life, sunbathes, and weighs 15 pounds less. Since her 20s, Susan (right) has spent as much time as she could in the sun (she has plenty of opportunity on Florida’s east coast, where she moved more than a decade ago). Jeanne, meanwhile, has aimed for “as little exposure as possible.” Besides causing Susan’s dark, patchy discoloration and age spots, UV light also reduces skin’s elasticity, increasing wrinkles and deepening creases, Guyuron says.
(Department of Plastic Surgery, University Hospitals Case Medical Center)
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Dina and Gina

Age: 27

Dina (left) weighs 50 pounds less than Gina (right), and hence looks younger, Guyuron says. “The added weight on Gina takes away definition in her jawline and projection in her cheekbones” — key factors in a youthful-looking face for women under 40, he notes. Dina, who lives in Georgia, actually reported significantly more sun exposure than her sister, in Florida. But for women in their 20s and 30s, whose sun damage hasn’t yet become fully visible, weighing less temporarily plays a more definitive role in looking younger, Guyuron says.
(Department of Plastic Surgery, University Hospitals Case Medical Center)
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For years, the similarities between Jeanne and Susan were uncanny. Growing up, the identical twin sisters not only were mirror images of each other, but also shared a bunch of preferences and personality quirks. Even now, living 1,000 miles apart — Jeanne in Ohio, Susan in Florida — “we’ll send identical Christmas cards to our parents and choose the exact same gift wrap,” Jeanne says. But they do have some differences, she adds: “We don’t have the same taste in men or in weather.”

In fact, unlike Jeanne, Susan is a lifelong sun worshipper. In addition, Susan began smoking in her late teens, and although she stopped for six years in her 20s, she averaged a pack and a half a day for 16 years before quitting in her late 30s. Jeanne never smoked. Over time, it seems, these habits have made a remarkable difference in the way they look. Now, “Susan looks ten years older than I do,” Jeanne acknowledges. “In fact, when we meet new people I’ll say, ‘She’s my sister,’ but I never say she’s my twin.”

It may seem odd that two people with the same DNA could look so different, but it’s common, according to research published in Plastic and Reconstructive Surgery by Bahman Guyuron, a plastic surgeon in Cleveland, and colleagues at Cleveland’s Case Western Reserve University. Contrasting behaviors cause subtle differences in appearance that eventually make one of the pair look older than the other. And that suggests that all of us — twins or not — may have more influence on the way we age than we think.

Catherine Deneuve has been credited with proclaimingthat after a certain age, a woman needs to choose between her face and her behind — meaning that a lean body can result in a face that appears gaunt and haggard. Indeed, for women over 40, this maxim is true, report Guyuron and his study co-authors, who surveyed and photographed 186 sets of identical twins. Additional weight fills in and softens wrinkles, making a heavier twin look younger than her sister, Guyuron explains.

But for women under 40, the effect turns out to be just the opposite: Extra pounds can obscure youthful features like a smooth jawline and cause facial skin to sag. The weight effect was generally seen when a woman had a body-mass index at least four points higher than her twin. (Each point of body mass is equivalent to five or six pounds of weight, so a four-point difference would be 20 to 24 pounds.)

The longer a woman takes birth control pills or hormone-replacement therapy, and the higher the dose, the more likely she is to look younger. That’s partly because estrogen can increase water retention, helping to smooth out the skin. And although estrogen is contraindicated for some women and poses health risks as well as benefits, there is no question that “estrogen improves skin elasticity,” Guyuron says. In one case, a 69-year-old who had used hormone replacement for four years longer than her twin looked three-and-a-third years younger, despite having had more lifetime sun exposure.

Taking antidepressants, however, was generally associated with an older appearance. In addition to the aging effect of depressed people’s sadder facial expressions, Guyuron says, certain depression-relieving drugs can weaken eye muscles, causing the area to look more droopy. (None of the twins who reported antidepressant use in the study were willing to be identified here.)

Women who didn’t drink looked younger than their twins who did. Since the study didn’t track the amount or type of alcohol that drinkers consumed, though, it wasn’t able to suggest exactly what constitutes too much. Actually, research has shown that resveratrol, a substance found in red-wine grapes, can delay aging, Guyuron points out. But in general, excess alcohol consumption can damage blood vessels in the skin. Also, “the liver plays a major role in the quantity and quality of the collagen fibers within the skin layers,” Guyuron says. Translation: Heavy drinking’s harm to liver function can cause wrinkles.

Cigarettes may not come with an aging warning, but evidently they should: The longer a woman smokes, the older she looks, with deeper and more plentiful wrinkles and more uneven skin tone. According to the research analysis, every 10 years of smoking resulted in a perceived extra 2.5 years of age.

More surprising, divorced women were judged to look an average of 1.7 years older than their married or single twins — possibly because of higher levels of stress or depression. (Marriage isn’t always smooth sailing, but it’s not as stressful as divorce.) Inexplicably, though, widows looked two years younger. No differences were found with increasing number of divorces, the researchers report. Guyuron guesses that “after one goes through a very challenging situation once, the second or third experience becomes less troubling and would not take as much toll on the face.”

If anyone dismisses the idea that sun exposure speeds up aging, this study may change their minds. The researchers calculated the approximate amount of time each woman had spent in the sun since childhood. The twins’ photographs, as shown on these pages, confirm that UV exposure deepens wrinkles and mottles the skin. Sunscreen use, however, minimized or prevented these effects.